Living with Diabetes

The Centers for Disease Control and Prevention (CDC) recently released guidance (see http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) to help decrease the spread of H1N1 flu among students and school staff during the 2009-2010 school year. The guidance provides a menu of tools that school and health officials can choose from based on conditions in their area, including basic recommendations such as frequent hand washing. The guidance also suggests strategies to use if CDC finds that the flu starts causing more severe disease than during the spring 2009 outbreak. Detailed information on the reasons for these strategies and suggestions on how to use them is included in a related CDC Technical Report
(see http://www.cdc.gov/h1n1flu/schools/technicalreport.htm#distance). 

In these materials, the CDC states that children with chronic illnesses such as diabetes are especially at risk for flu complications (high risk groups also include pregnant women, and persons who have asthma, compromised immune systems, or neuromuscular diseases).  As a result, children with diabetes are a target group to receive the vaccine when it becomes available (see http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm).
The agency recommends that people in these groups who become ill with influenza-like illness speak with their health care provider as soon as possible.  Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths.

The agency also recommends that, if there is an increased level of flu severity (the flu becomes more dangerous), students in high risk groups may consider staying at home from school under certain circumstances. 

As discussed below, based on this guidance, the ADA is recommending that parents/guardians consider discussing the school’s planned response to H1N1 with the student’s education team, and adding specific language to their children’s education plan to address the H1N1 virus. Below are relevant parts of the CDC’s guidance and the ADA’s recommended changes for education plans.

CDC Recommendations during Times of Increased Flu Severity

In relevant part, the CDC’s technical report provides as follows:

CDC will continue to assess the severity of illness caused by 2009 H1N1 flu and disseminate the results of these ongoing assessments. If global or national risk assessments indicate an increased level of severity compared with the spring 2009 H1N1 flu outbreak, CDC will consider the need to recommend additional strategies including preemptive school dismissals.

Decisions to add strategies should be based on information on the severity of illness reported in national and global assessments, local goals, epidemiology, health care system capacity, and feasibility and acceptability of the strategies under consideration. The strategies which follow use a variety of methods for increasing social distance, while attempting to maintain operability of most schools. Feasibility and acceptability of these strategies will vary considerably across communities. Except for school dismissals, the following strategies have not been scientifically tested. But CDC wants communities to have tools to use that may be the right measures for their community and circumstances.

One of the recommendations applicable in the event that the CDC finds an increased level of flu severity is that students (and staff) “consider staying home from school while flu transmission is high in their community if they, or their families, are concerned about their ability to avoid influenza at school.”  Specifically, CDC states:

The decision about whether to stay home should be made in consultation with [the student’s] health care provider.  People who elect to stay home from school should also attempt to decrease their exposure in other ways for example, by avoiding large public gatherings. Well students should be expected to continue their education while at home as much as possible.
Schools should prepare for discussions with parents about school safety and should consult with school boards and legal counsel about policy accommodations that might be necessary to allow students and staff at high risk for influenza complications to stay home. Local and state laws and policies also might need to be reviewed for applicability. Policies to be reviewed may be official or unofficial, such as school principals’ awards for students with perfect attendance. Schools should plan now for ways to continue educating students who stay home through methods such as instructional telephone calls, homework packets, internet-based lessons, and other distance-based learning approaches.

ADA Recommendations

At this point in time, the CDC cannot predict if and when the flu will increase in severity.  Thus, it cannot be predicted if and when the agency’s recommendation on staying home from school (in the event flu transmission is high in the community) will become applicable.  However, to be on the safe side, the ADA  recommends that families consider amending the student’s education plan now to address this concern. That way, if public health officials, such as city or state health departments or the CDC, report that H1N1 has become more severe than it was in the spring of 2009, families will be in a position to take appropriate action. 

We have developed language for inclusion in the student's Section 504 Plan, IEP, or other written accommodation plan which is designed to ensure that parents/guardians receive notice about flu outbreaks in their child’s school (which we believe raise concerns about exposure which are comparable to the situation where flu transmission is high in the community generally).  This will provide parents/guardians an opportunity to consult with their child’s health care provider regarding whether the child should stay home. The suggested language also provides that, if such decision is made, the student will not be penalized for absences.

Suggested Language for Inclusion in Students’ Section 504 Plan, IEP or Other Written Accommodation Plan

The school nurse or school administrator shall promptly notify the parent/guardian if there is reason to believe that another student who shares a classroom with the child has come down with the flu or if there is a general outbreak of flu among students and/or school staff (no personal identifiers need be released). The parent/guardian and the child's health care provider will use this information to determine whether the student should stay home from school in order to avoid exposure. Upon request by the school, the parent/guardian shall provide documentation from the child's health care provider advising the student to stay home. The student shall not be penalized for related absences and shall have access to the same alternative education services as would be provided to any other student who is medically required to remain home under similar circumstances.

More information 

Various organizations, including the Centers for Disease Control (CDC), recommend that school districts develop plans regarding student health and safety and the H1N1 flu. The U.S. Department of Health and Human Services has developed a website with relevant CDC, U.S. Department of Education, and other organization documents on this topic. Your state department of education may also have relevant on-line H1N1 guidance for schools in your state.

http://www.flu.gov/professional/school

http://www.doe.in.gov/sservices/H1N1/school.html  
(Indiana Department of Education H1N1information)